Christ Hospital: RSV Poses Serious Risks for Newborns, Seniors

From the The Christ Hospital Health Network

Feel like you’re hearing a lot more about “RSV” lately? You’re not alone. Respiratory Syncytial Virus is a common and potentially serious viral infection that affects people of all ages, especially newborns and older adults.

“RSV is a seasonal virus, and it tends to come on in the wintertime,” says Benjamin Smith, MD, a family medicine specialist with The Christ Hospital Physicians – Primary Care​. “It usually peaks in January or February, and then starts trailing off in the spring kind of like the flu.”

​RSV symptoms often look like the common cold, so it can easily be dismissed as a minor illness. However, understanding the risks and recognizing the symptoms is crucial for the well-being of your loved ones.

What is RSV?

​RSV is a highly contagious virus that primarily affects the lower respiratory system. It’s a member of the same family of notable viruses as measles and mumps. RSV is so common that most people will be infected with it at some point in their lives.

“RSV has been around for as long as the common cold,” Dr. Smith says. “Research has shown that by age two, pretty much everyone has had RSV.”

While RSV can cause mild cold-like symptoms in healthy individuals, it can lead to severe respiratory illness in certain high-risk populations.

“Any sort of major organ disease, chronic disease of the kidney or liver, lungs or heart can make you much more susceptible to having a severe infection from RSV,” Dr. Smith says. “As long as your symptoms aren’t causing danger to you, we would treat them just like any other common cold.”

​Who is at higher risk for RSV?

RSV doesn’t discriminate when it comes to making someone sick. It can affect people of all ages, but the severity of the illness and the risk factors can vary significantly.

Understanding who’s most at risk is crucial for early intervention and prevention. The following groups are particularly vulnerable to RSV:

1. Infants and Young Children: Babies, especially premature infants or those with certain medical conditions, are at a higher risk of severe RSV infection. RSV can lead to bronchiolitis or pneumonia in these young ones.

2. Older Adults: Elderly individuals, especially those over 65, are at risk of severe RSV infection, which can lead to pneumonia. Weakened immune systems and other health issues contribute to this vulnerability.

3. People with Weakened Immune Systems: Those with compromised immune systems due to diseases like HIV/AIDS, cancer, or organ transplantation are more susceptible to severe RSV infection.

4. Individuals with Chronic Health Conditions: People with chronic lung or heart diseases like asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure are at increased risk of complications from RSV.

​RSV in Infants and Children

​As many as 80,000 ch​​​ildren under the age of 5 are hospitalized because of an RSV infection every year, according to the Centers for Disease Control and Prevention. Most improve with supportive care, but they may need oxygen, IV fluids, or a ventilator during their hospital stay.

“Infants don’t have as much space in their lungs and airways as adults,” Dr. Smith explains. “The type of congestion that RSV causes is more disruptive to those smaller airways, which makes it quite difficult for the little ones to take productive breaths.”

Most children who get RSV will only have mild symptoms. Dr. Smith says that children with a severe RSV infection can have some notable changes in their breathing. Those changes can be seen around the nose and on the chest and belly.

“They’re more likely to have increased work of breathing, which we would identify by looking for flared nostrils,” Dr. Smith says. “They may also be trying to suck in so much air that you can see something called ‘retractions’ where the stomach and chest muscles are actually pulling to get more air in that breath.”

Moms can protect their newborns by getting an RSV vaccination during pregnancy. The American College of Obstetrics and Gynecology and the American Academy of Family Physicians both recommend pregnant women get vaccinated against RSV anytime between 32 and 36 weeks.

There is an additional immunization for young children at highest risk for catching RSV. “Nirsevimab is a medication injection similar to a vaccine given prior to RSV season which can prep the body to fight RSV before it even starts,” Dr. Smith explains. “The antibodies help the immune system recognize the virus and kill it before it turns into an active infection.”

The CDC recommends the immunization for all infants under age 8 months entering their first RSV season. As of this publication in November 2023, the nirsevimab immunization was in short supply and only recommended for newborns at highest risk for complications.

​RSV in Seniors

Adults over the are of 60 are at increasing risk for serious complications from RSV. “Any illness can hit you a little harder when you’re older,” Dr. Smith says. “Your immune system is not quite as strong.”

According to the CDC, the RSV virus causes up to 160,000 hospitalizations and 10,000 deaths among older adults every year.

“RSV will sometimes progress into viral pneumonia,” Dr. Smith says. “When patients have heart failure or COPD, you’re already usually having some baseline issues with your breathing, and you just don’t have the capacity to handle something additional on top of that as much as others.”

“In addition to that, you can develop bacterial infections on top of RSV if you’re more susceptible or have a weaker immune system,” Dr. Smith continues. “That can develop into bacterial pneumonias and other conditions.”

RSV vaccines are now available and highly encouraged for adults ages 60 and older. “They are excellent options for those age groups,” Dr. Smith says. “I’ve been suggesting it to all my patients who qualify for it.”

The CDC says you can get the RSV vaccine at the same time as your other annual vaccines like the flu shot.

​Recognizing RSV Symptoms

RSV symptoms can be easily confused with those of the common cold, which makes it essential to be vigilant, especially if you or your loved ones are in a high-risk group.

Here are the key symptoms to watch for:

1. Coughing: Persistent coughing, often with phlegm or mucus, is a common symptom of RSV. The cough may be severe, making it hard to breathe.

2. Sneezing and Runny Nose: Like a cold, RSV often begins with sneezing, a runny or stuffy nose, and a mild fever.

3. Fever: A low-grade fever (less than 100.4°F or 38°C) is another typical RSV symptom. In some cases, the fever can spike higher.

4. Wheezing: Wheezing, a high-pitched whistling sound when breathing, is a significant symptom of RSV in infants and young children.

5. Breathing Difficulties: RSV can cause rapid, shallow, or labored breathing in both infants and adults, making it challenging to get enough air.

6. Irritability: Infants and young children may become unusually fussy, cranky, or lethargic when infected with RSV.

7. Decreased Appetite: In infants, a decreased appetite and reduced intake of fluids can be a sign of RSV infection.

8. Bluish Skin or Lips: This is an emergency symptom. If you notice bluish or grayish skin or lips, seek immediate medical attention.

​When to Seek Medical Attention

​RSV can lead to severe complications, especially in high-risk individuals, so it’s essential to know when to seek medical care.

“You definitely want to get care if you have a viral illness of any kind and you have a history of COPD, asthma or heart failure or if you’re having any kind of difficulty breathing,” Dr. Smith says.

If you or your loved ones experience any of the following, don’t hesitate to consult a healthcare professional:

1. Severe coughing, wheezing, or difficulty breathing
2. High fever (above 100.4°F or 38°C)
3. Rapid breathing or noticeable chest retractions in infants
4. Extreme fussiness or irritability in infants
5. Difficulty staying awake or appearing very lethargic
6. Dehydration signs, such as a dry mouth, sunken eyes, or decreased urination.

​Preventing RSV

There are measures you can take to reduce your risk of catching RSV and spreading it to others. “When you have something that could be RSV, you definitely want to keep your distance, especially around those that are most susceptible to severe forms of RSV,” Dr. Smith recommends.

You can also follow these tried-and-true methods to prevent the spread, which also work for other respiratory illnesses.

1. Frequent Handwashing: Regularly wash your hands and encourage children to do so as well. Hand hygiene is one of the most effective ways to prevent the spread of RSV.
2. Avoid Close Contact: If you or your child is infected with RSV, it’s crucial to avoid close contact with high-risk individuals, such as infants and the elderly.
3. Cough and Sneezing Etiquette: Teach good cough and sneeze hygiene by covering the mouth and nose with a tissue or elbow, not hands.
4. Cleaning and Disinfecting: Keep surfaces and objects clean and disinfected, especially if someone in your household is sick.
5. Stay Informed: Stay informed about RSV outbreaks in your area and take extra precautions when it’s on the rise.

By staying informed and vigilant, you can protect yourself and your loved ones from the potential dangers of RSV. Remember, when in doubt, talk to your doctor or another healthcare professional to ensure the best care and guidance.​